The push for evidence-based guidelines in workers’ compensation is understandable. Workers’ compensation is one of the few areas of medicine in which healthcare protocols are not well scripted in advance of patient encounters. In addition, patients have no responsibility for payments such as deductibles and copayments. That leaves employers liable for 100 percent of all reasonable and required medical care.
But who decides what treatment is reasonable and required? One would naturally think that it is the treating provider. But the current fee-for-service model offers a financial incentive for doctors to perform and bill for treatments and procedures, preferably those with high margin codes.